What is a Medicare FDR attestation?
First Tier, Downstream and Related Entity (FDR) Compliance Attestation. CMS requires any organization or individual that contracts with Health Partners Plans (HPP) to provide administrative or health care service functions on behalf of HPP comply with various CMS program requirements.
What is an FDR representative?
FDR stands for first tier, downstream and related entities. If you perform administrative or health care services on behalf of Aetna's Medicare business, then you are an FDR.
What is FDR oversight?
As part of the FDR oversight program, the Company requires a party responsible for compliance at an FDR, such as a Compliance Officer or General Counsel, to attest to the following: • standards of conduct and compliance policies are disseminated to all employees within 90 days of hire, when there are updates to the ...
What is a Medicare Advantage sponsor?
CMS uses the term “plan sponsor” to describe an organization that has an approved, active contract with the federal government to offer Medicare Advantage plans, prescription drug plans, and 1876 cost plans. A plan sponsor can be an employer, a union, or a health insurance carrier.Oct 19, 2017
What is a first tier entity Medicare?
The term first tier entity means any party that enters into a written arrangement with an MA organization or contract applicant to provide administrative services or health care services for a Medicare eligible individual.
What is a downstream entity Medicare?
Downstream Entity – any party that enters into a written arrangement, acceptable to CMS, with persons or entities involved with the MA benefit or Part D benefit, below the level of the arrangement between an MAO or applicant or a Part D plan sponsor or applicant and a first tier entity.
What are the seven elements of a compliance program?
Seven Elements of an Effective Compliance ProgramImplementing written policies and procedures. ... Designating a compliance officer and compliance committee. ... Conducting effective training and education. ... Developing effective lines of communication. ... Conducting internal monitoring and auditing.More items...
What are the seven basic components of a compliance plan?
Seven Elements of an Effective Compliance ProgramImplementing Policies, Procedures, and Standards of Conduct. ... Designating a Compliance Officer and Compliance Committee. ... Training and Education. ... Effective Communication. ... Monitoring and Auditing. ... Disciplinary Guidelines. ... Detecting Offenses and Corrective Action.Jan 8, 2020
What must all Medicare Advantage sponsors have in place to meet CMS guidelines?
Medicare Advantage Plans Must Follow CMS Guidelines In the United States, according to federal law, Part C providers must provide their beneficiaries with all services and supplies that Original Medicare Parts A and B cover. They must also provide any additional benefits proclaimed in their Part C policy.
Who is the largest Medicare Advantage provider?
UnitedHealthcareUnitedHealthcare is the largest provider of Medicare Advantage plans and offers plans in nearly three-quarters of U.S. counties.Dec 21, 2021
Which of the following must you not do when marketing UnitedHealthcare Medicare Advantage?
As an agent, you must not do which of the following when marketing UnitedHealthcare Medicare Advantage plans to consumers? Use providers or provider groups to distribute printed information comparing benefits of different health plans without approval.
Does Medicare use capitation?
Medicare pays Medicare Advantage plans a capitated (per enrollee) amount to provide all Part A and B benefits. In addition, Medicare makes a separate payment to plans for providing prescription drug benefits under Medicare Part D, just as it does for stand-alone prescription drug plans (PDPs).Jun 6, 2019
What is FDR in Medicare?
FDR stands for first tier, downstream or related entity. We use the CMS definitions of these vendor types: 1 First Tier Entity – any party that enters into a written arrangement, acceptable to CMS, with a Medicare Advantage Organization or Part D plan sponsor or applicant to provide administrative services or healthcare services to a Medicare eligible individual under the Medicare Advantage program or Part D program. (See 42 C.F.R. §§ 422.500 & 423.501). 2 Downstream Entity – any party that enters into a written arrangement, acceptable to CMS, with persons or entities involved with the Medicare Advantage benefit or Part D benefit, below the level of the arrangement between a Medicare Advantage Organization or applicant or a Part D plan sponsor or applicant and a first tier entity. These written arrangements continue down to the level of the ultimate provider of both health and administrative services. (See 42 C.F.R. §§ 422.500 & 423.501). 3 Related Entity – any entity related to a Medicare Advantage Organization or Part D sponsor by common ownership or control that: 1. Performs some of the Medicare Advantage Organization’s or Part D plan sponsor’s management functions under contract or delegation; or (2) Furnishes services to Medicare enrollees under an oral or written agreement; or (3) Leases real property or sells materials to the Medicare Advantage Organization or Part D plan sponsor at a cost of more than $2,500 during a contract period. (See 42 C.F.R. §§ 422.500 & 423.501).
What is a FDR?
These entities , known as FDRs, help Medical Mutual to be more cost effective and efficient. Some services provided by external entities are required under our contracts with the Centers for Medicare and Medicaid Services (CMS) and, therefore, need additional oversight to ensure compliance.
How to report medical mutual?
If you suspect Fraud, Waste, Abuse or non-compliance, you are obligated to report the incident to Medical Mutual immediately. You can report the incident anonymously by phone at (800) 762-8130 or 1-800-553-1000. You can also report online.
Who must attest to Medicare compliance?
If you are an FDR, prior to your contract and annually thereafter, an authorized representative from your organization must attest to your compliance with the Medicare Compliance Program requirements. You can complete your annual attestation online here.
What is a first tier entity?
First Tier Entity – any party that enters into a written arrangement, acceptable to CMS, with a Medicare Advantage Organization or Part D plan sponsor or applicant to provide administrative services or healthcare services to a Medicare eligible individual under the Medicare Advantage program or Part D program.
What is Medicare compliance program?
The Medicare Compliance Program requirements apply to entities that Medical Mutual contracts with to perform administrative and healthcare services relating to MA/PD contracts with CMS.
Do you have to disclose medical mutual?
You must disclose to Medical Mutual if you or any of your sub-contractors offshore. If the functions performed by the offshore entity involve personal health information (PHI), Medical Mutual must submit an attestation to CMS. You can complete the offshore attestation online here.
What Is An FDR?
- FDR stands for first tier, downstream or related entity. We use the CMS definitions of these vendor types: 1. First Tier Entity –any party that enters into a written arrangement, acceptable to CMS, with a Medicare Advantage Organization or Part D plan sponsor or applicant to provide administrative services or healthcare services to a Medicare eligi...
Attestation Requirements
- If you are an FDR, prior to your contract and annually thereafter, an authorized representative from your organization must attest to your compliance with the Medicare Compliance Program requirements. You can complete your annual attestation online here. In the event of a CMS audit or upon request, you may also be asked to provide evidence of your compliance with the require…
Are You An FDR?
- Medical Mutual established a procedure to identify all FDRs. We used the criteria outlined in Chapter 21of the Medicare Managed Care Manual. We gave you this web address because we’ve identified you as an FDR.
Requirements For Fdrs
- It’s important that our FDRs are in compliance with applicable laws, rules and regulations. The Medicare Compliance Program requirements apply to entities that Medical Mutual contracts with to perform administrative and healthcare services relating to MA/PD contracts with CMS. Although we contract with FDRs, Medical Mutual is ultimately responsible for fulfilling the terms …